Older
patients with lower back pain are increasingly getting more complex and
costlier spinal fusion surgeries, resulting in higher rates of life-threatening
complications and increasing costs for the healthcare system, U.S. researchers
said on Tuesday. A study of records from the federal Medicare program for the
elderly and disabled between 2002 and 2007 revealed a 15-fold increase in the
rate of complex surgeries to treat spinal stenosis -- a common condition in the
elderly in which the spinal canal narrows, causing pain in the back and legs. And
while the number of overall procedures to treat this problem dipped during the
period, hospital charges for those surgeries rose by 40 percent on an
inflation-adjusted basis, Dr. Richard Deyo of the Oregon Health and Science
University in Portland and his colleagues reported in the Journal of the
American Medical Association. In a telephone interview Deyo said the trend in
part is related to the introduction of new technology, such as spinal cages and
special screws used to fuse vertebrae together. But
it also reflects savvy marketing by orthopedic device makers such as Stryker
Corp., Medtronic Inc. and Johnson & Johnson's DePuy unit, that has
convinced surgeons more complex surgery is better, Deyo said. Studies, however,
suggest complex spinal fusion surgeries offer little benefit over simpler
procedures for most patients, and increase the risk of complications. "It
is driving up the cost of care without much evidence that it is improving
care," Deyo said. A study last year published in JAMA found that the cost
of treating spine problems in the United States rose 65 percent in the past
decade to $85.9 billion a year, rivaling the economic burden of treating
cancer, which costs $89 billion. Yet, for all of the spending, they found
people with spine problems actually felt worse. Deyo's team studied three
specific surgical procedures for lumbar stenosis: decompression, in which part
of the vertebrae is removed to ease pressure on nerve roots; simple fusion, in
which one or two discs are fused together through an incision in the back or
abdomen; and complex fusion, in which more than 3 vertebrae are treated or the
surgery is done from both the back and front. Overall,
the procedure rate fell 1.4 percent during the study period, but rates of
complex fusion surgery increased from 1.3 per 100,000 patients to 19.9 per
100,000. "What happened was the most complex type of surgery increased
15-fold over that period of time, a far more rapid increase than we could
explain just on the basis of more severe disease," Deyo said. "What
we also found is these more complex operations are associated with a higher rate
of serious complications." Patients in the study who had a complex fusion
procedure had a nearly three times higher odds of a life-threatening
complication compared with those who only got decompression. And overall
hospital charges rose 40 percent in inflation-adjusted dollars, the team found.
Dr. Eugene Carragee of the Stanford University School of Medicine in California
said in a commentary that the study should remind patients, doctors and
insurance companies to carefully weigh the options for spinal surgery. "...
the efficacy of basic spinal techniques must be assessed carefully against the
plethora of unproven but financially attractive alternatives," Carragee
wrote, noting that "financial incentives and market forces do not favor
this careful assessment before technologies are widely adopted."